CMS Price Transparency Data

Hepatitis C antibody test

Facility: Vandalia Health Broaddus Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $57
Cash Discount Price: $47
vs. Medicare Baseline: 3.99x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Vandalia Health Broaddus Hospital is $57. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.99x the Medicare baseline. Located in 1 Healthcare Drive Mansfield Hill, Philippi, WV.

Cash / Self-Pay

$47

Average discount available for prompt cash payment at this facility.

Insurance Median

$57

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14.27

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14.27 (100%)

Cash / Self-Pay: $47 (329%)

Insurance Median: $57 (399%)

Cash: $47 (329% of Medicare)

Ins. Median: $57 (399% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14.27 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 399% of the Medicare baseline (a markup of 299%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Peak Health	$11 - $24	77%
Aetna	$13 - $66	91%
Blue Cross Blue Shield	$23 - $52	161%
Highmark	$45 - $54	315%
The Health Plan	$45 - $67	315%
UnitedHealthcare	$45 - $72	315%
Humana	$47 - $57	329%
West Virginia Senior Advantage	$47 - $58	329%
Cigna	$53 - $65	371%
First Health	$55 - $66	385%
Geisenger Health Plan	$57 - $69	399%
Health Network America	$57 - $70	399%
Multiplan/Phcs	$57 - $70	399%
Geha	$58 - $70	406%
Selectnet	$60 - $73	420%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $47.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86803.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Vandalia Health Broaddus Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 86803.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.